Sever’s or “calcaneal apophysitis” is a common condition affecting children. It is characterized by an insidious onset of heel pain that usually worsens rapidly. Any child can develop symptoms, however it more commonly affects physically active children, and is more common in boys. It develops just before puberty and is most often seen in girls aged 9-11 and boys aged 10-12. Despite being a fairly common condition, many parents are unaware of the signs and symptoms, the management on the condition and the long term prognosis for their child. This blog will help explain the condition and pathways of management used by physiotherapists and podiatrists.
What is Sever’s? Sever’s is inflammation and subsequent pain in the growth plate or “epiphyseal plate” in the heel of the foot. Growth plates are found at the ends of developing bones and contain cartilage cells that form into adult bone. This process occurs during a growth spurt in children and is how their bones grow.
When this process is occurring the growth plates are weaker as they have not fully formed into adult bones. In this period of rapid growth, a child’s bones grow faster than their muscles causing them to be become tight. In the instance of Sever’s the calf muscle and achilles tendon are pulled tight resulting in pain and inflammation where it attaches to the sensitive developing bone on the heel.
Signs and Symptoms
· Pain in the heel area or achilles tendon on one or both feet · Pain during and/or after exercise · Worsened by impact activities like running, jumping, landing · Worsens with exercise often improves with rest · Swelling at the heel and can be sore to touch · Calf muscle tightness · Limping or walking on toes
Factors that can contribute to developing Sever’s
· Being physically active · Wearing inappropriate shoes during sport · Playing sport on hard surfaces · Pronated feet · A flat or high arch (both cause tightening of the Achilles tendon)
Diagnosing Sever’s One of our Podiatrist in Kew, or Podiatrists in Oakleigh can usually diagnose Sever’s from asking questions and a simple assessment of the foot. An x-ray is not necessary but can show changes to bone to help diagnose and also rule out other possibilities like a fracture.
Treatment Initial management: · Rest from activity until pain resolves · Ice after exercise or end of day · Stretching for calf muscle and achilles · Wearing well fitting supportive footwear · Heel lift in shoes to offload the tight achilles tendon · In more severe cases when bone is heavily disrupted your child may be prescribed a cushioned boot by their physiotherapist or podiatrist. These are worn for a few weeks to limit weight bearing through the foot and allow the bone and growth plate to properly heal Once symptoms have settled your child can return to activity gently. Your physiotherapist will usually advise you to begin with lighter activity and progress to higher impact activity to ensure the growth plate is not aggravated causing a flare up of symptoms.
Prognosis Once the child’s initial rapid growth slows, symptoms generally resolve with no long term effects. Flare ups can occur over months during puberty but are only self limiting, meaning they are temporary and will settle with rest. If the child continues to overload the foot with activity and “push through the pain” there is a risk of malformation of the growth plate into adult bone, however this is uncommon and if treated properly will not result. Although the management for Sever’s is relatively simple, it is best to be guided by a physiotherapist or podiatrist to ensure your child has a successful recovery. If you think your child may be experiencing any of Sever’s symptoms come in and see us for an assessment.
If your child is experiencing any heel pain, or any other foot, leg or knee issues you should book an appointment with one of our podiatrists in Kew or podiatrists in Oakleigh, who are able to conduct a thorough gait and biomechanical assessment. To contact us you can give us a call on (03) 9568 1011 or alternatively you can book an appointment online.
